Provider Demographics
NPI:1982848537
Name:DURAN - PONCE, EVELYN (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:DURAN - PONCE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4831
Mailing Address - Country:US
Mailing Address - Phone:631-979-9700
Mailing Address - Fax:631-265-5297
Practice Address - Street 1:732 SMITHTOWN BYP 103
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5020
Practice Address - Country:US
Practice Address - Phone:631-265-5545
Practice Address - Fax:631-265-8042
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005188-1133NN1002X
NY855320133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education